Gallstones: When they are harmless – and when the gallbladder needs to be removed

The gallbladder lies beneath the liver and stores the bile produced there. Between meals, this bile is concentrated and, when needed, released into the small intestine, where it aids in the digestion of fats. Gallstones can form when the components of bile become unbalanced, leading to the formation of crystals. Most stones consist mainly of cholesterol. Less commonly, they are pigment stones, which contain bilirubin, amongst other substances.

The risk increases, amongst other things, with advancing age and a family history of the condition. Pregnancy, certain hormonal influences, diabetes, severe obesity and rapid weight loss can also contribute to their development. GLP-1 receptor agonists, which are used to treat diabetes and for weight loss, are also associated with an increased risk of gallstones and other diseases of the bile ducts. In a large review of randomised trials, the risk was found to be higher, particularly at higher doses and with prolonged use. Rapid weight loss itself can also contribute to the formation of stones.

Many gallstones are discovered incidentally during an ultrasound scan, but as long as they do not cause any typical symptoms, treatment is not usually necessary.

The situation is different if typical biliary colic occurs repeatedly or if complications arise. In such cases, removal of the gallbladder may well be advisable.

Typical complications include, for example:

• Inflammation of the gallbladder
• Blockage of a bile duct
• Inflammation of the bile ducts
• Inflammation of the pancreas

In the event of acute inflammation or a blocked bile duct, an endoscopic procedure may be necessary in addition to surgery.

A biliary colic occurs when a stone blocks the flow from the gallbladder. It is characterised by sudden, severe pain in the right or central upper abdomen, which may radiate to the back or the right shoulder. This pain often occurs after a meal containing fatty foods, can be very intense and may persist for some time.

Nausea and vomiting may also occur. Fever or chills, on the other hand, are more indicative of inflammation. Yellowing of the skin or eyes may suggest that a stone has entered a larger bile duct.

Unfortunately, a special diet cannot dissolve existing gallstones. In particular, very high-fat and large meals can trigger symptoms because the gallbladder contracts after eating. Which foods actually cause problems varies from person to person.

It often helps simply to spread smaller meals throughout the day and to cut down on particularly fatty foods to begin with. These include, for example, very fatty meat, fried foods or particularly rich cream sauces. A diet that is as balanced as possible, with plenty of vegetables, wholegrains and other fibre-rich foods, is advisable. By contrast, a radical diet or extreme fasting is not a suitable treatment for gallstones.

If gallstones repeatedly cause symptoms or lead to complications, the entire gallbladder is often removed. This procedure is known as a cholecystectomy. Removing the gallstones alone would not eliminate the risk of new stones forming in the remaining gallbladder.

Nowadays, the gallbladder is usually removed using a minimally invasive approach via laparoscopy. This involves making several small incisions through which a camera and surgical instruments are inserted.

With the single-port technique, access is gained via a single small incision in the navel area. This results in less visible scarring. The method is technically more demanding and is not suitable for every case. Studies show particular advantages in terms of the cosmetic outcome. If stones are present not only in the gallbladder but also in the common bile duct, they can often be removed endoscopically. To do this, an endoscope is guided through the mouth and down the gastrointestinal tract to the bile duct.

The gallbladder is not necessary for the production of bile, as this continues to be produced by the liver. After removal, bile flows via the bile ducts into the bowel, rather than being stored in the gallbladder as before.

Most people can eat normally again after a cholecystectomy. No special long-term diet is required. Some patients may initially experience looser stools, more frequent bowel movements or diarrhoea, particularly after very high-fat meals.

It is also important to note that whilst surgery eliminates the typical colic attacks caused by gallstones, it does not guarantee that all pre-existing digestive complaints will disappear. A feeling of fullness or bloating, for example, may have a different cause.

Gallstones do not automatically require treatment. If they remain asymptomatic, monitoring is usually sufficient. Recurrent colic or complications, on the other hand, may necessitate removal of the gallbladder. In the event of severe upper abdominal pain, fever, jaundice or persistent vomiting, the cause should be investigated by a doctor as soon as possible.